Anxiety of pregnant women in the third trimester in facing childbirth: A literature review

 Corresponding author: Niadari Yulia Dwi Lestari Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution Liscense 4.0. Anxiety of pregnant women in the third trimester in facing childbirth: A literature review Niadari Yulia Dwi Lestari * Midwifery Program, Faculty of Medicine, Airlangga University, Surabaya, Indonesia. World Journal of Advanced Research and Reviews, 2025, 26(03), 2449-2456 Publication history: Received on 16 May 2025; revised on 23 June 2025; accepted on 25 June 2025 Article DOI: https://doi.org/10.30574/wjarr.2025.26.3.2434 Abstract Introduction: During the third trimester of pregnancy, pregnant women will have feelings such as anxiety and fear of death, birth trauma, fear that their baby will be born with a disability, anxiety about the birth of the baby and changes in the phase of their life are certainly also felt by pregnant women at the same time. Method: The research design used in this paper is a literature review with 10 journals, 3 international journals and 7 national journals. Result and Discussion: Of the ten articles used in this literature review, several of them showed a significant influence of family support, especially from the husband, education, and aromatherapy on maternal anxiety when facing childbirth, both primigravida and multigravida. Conclusion: Anxiety in dealing with childbirth can be experienced by pregnant women, both primigravida and multigravida. Factors that cause anxiety are age, experience, information from health workers, and beliefs from stories in the environment. Keywords: Pregnancy anxiety; Husband's Support; Aromatherapy; Pregnant Women TM III 1. Introduction Pregnancy is a process that starts from conception to childbirth, which is divided into three trimesters: trimester I (12 weeks), trimester II (15 weeks), and trimester III (13 weeks) (Saifuddin in Elisabeth, 2018). During pregnancy, hormonal changes occur that can cause emotional changes in the mother, such as anxiety and depression. This anxiety can appear from the first trimester until before delivery. However, research shows that levels of anxiety and depression increase almost two-fold in the second and third trimesters compared to the first trimester. Pregnant women who experience high anxiety, especially in the third trimester, can release high levels of stress hormones (catecholamines), which have an impact on increasing labor pain, the length of the labor process, and tension before birth (Batubara, Daulay, and Rangkuti, 2020). Anxiety is a feeling of fear that something will happen due to anticipation of danger and is a signal that helps individuals prepare themselves to take action to face a threat. One of the psychological impacts caused is anxiety or worry. Anxiety is a universal experience in every human being, an emotional response that causes an unpleasant feeling, a feeling of worry that cannot be realized and is not identified from where the source and direction of the thoughts come (Solehati and Kosasih 2018). The factors that can influence anxiety during pregnancy in a mother are lack of family support, knowledge, maternal age, education level, and maternal occupation (Soewandi in Ice Rakizah Syarie, 2016). Factors that World Journal of Advanced Research and Reviews, 2025, 26(03), 2449-2456 2450 influence anxiety in pregnant women include, maternal education level, maternal age, and family support, one of which is husband's support. 2. Material and methods The research method used in this research is the literature review method. The journals used in this study are national and international journals. The journals reviewed in this study totaled 10 journals from 7 national journals and 3 international journals. Data searches in the research were carried out by searching from sources such as journal portal websites that can be accessed such as Pubmed, Google Scholar and others. The articles used adjust to the search keywords related to the literature review. 3. Results Ten articles— seven in Indonesian and three in English—have been reviewed and analyzed as follows World Journal of Advanced Research and Reviews, 2025, 26(03), 2449-2456 2451 Table 1 Results of Review of 10 Articles No Author Research Title Location Method Subject Result 1 Halil, A., and Puspitasari, E. (2023) Factors that cause anxiety in pregnant women in the third trimester when facing childbirth at the Depok Health Center Puskesmas Depok 2 The study employed a descriptive analytical method with a crosssectional approach Data collection utilized two questionnaires: demographic information and the HARS 50 pregnant women in their third trimester. he study found no significant relationship between age and anxiety levels in pregnant women (p-value 0.340) . There was no significant correlation between parity and anxiety levels (p-value 0.288). A significant relationship was found between occupation and anxiety levels (p-value 0.041) . Education level did not significantly affect anxiety levels (p-value 0.553) . The majority of respondents experienced moderate anxiety, with 62% reporting this condition . The study aimed to explore the relationship between age, education, parity, and occupation with anxiety levels in pregnant women 2 Muzayyana, M., and Saleh, S. N. H. (2021). Analysis of Anxiety Level Factors of Third Trimester Pregnant Women in Facing the Childbirth Process During the Covid-19 Pandemic in Kotamobagu City in Kotamobagu City, specifically at five Puskesmas The type of research used is descriptive quantitative with a cross sectional design using an observational approach with a questionnaire as a tool. The population in this study was 105 pregnant women in the third trimester. The sample in this study was 65 people. The paper highlights that psychological burdens in pregnant women peak during the third trimester, leading to abnormal deliveries and potential maternal and fetal mortality. It reports that 67% of pregnant women experience anxiety before delivery, with 12% feeling very anxious. The study indicates that anxiety levels increase from 8-10% during pregnancy to 12% as delivery approaches. It emphasizes the global maternal mortality rate of 289,000, with Indonesia having the highest rate at 214 per 100,000 live births 3 Setiati, N. W. (2019) The Effectiveness of Lavender Aromatherapy to Reduce Anxiety in Third Trimester Pregnant Women in Preparation for Childbirth at Independent Midwife Practice Nurussyifa, Buniseuri District, Ciamis Independent Midwife Nurrusyifa Buniseuri Ciamis The type of research used in this study is experimental research. The experimental research design uses a quasiexperimental model with a two-group pretest-posttest design. The anxiety measurement tool uses a standard The sample used was selected by purposive random sampling, from 67 people, 40 people were taken as research respondents. In this study, it was found that there was a decrease in anxiety levels after being given lavender aromatherapy. Aromatherapy patients who receive this aromatherapy will feel calm, comfortable, relaxed, satisfied and will be closer to the health workers who serve them so that indirectly this can reduce the level of anxiety felt. World Journal of Advanced Research and Reviews, 2025, 26(03), 2449-2456 2452 questionnaire from STAI (Spielberger State-Trait Anxiety Inventory, while the administration of lavender aromatherapy uses the inhalation method for 3-5 minutes. 4 Situmorang, R. B., Rossita, T., and Rahmawati, D. T. (2020). The relationship between age and education and the level of anxiety in pregnant women in the third trimester when facing childbirth in Mukomuko district, Bengkulu province. in Mukomuko Regency using analytic with descriptive method research using a cross-sectional study design The population in this study was all primigravida pregnant women in the third trimester who had anxiety during pregnancy in Mukomuko Regency, totaling 33 respondents. The results of the study showed that there was a significant relationship between maternal age and anxiety in primigravida pregnant women in the third trimester with a p-value of 0.016. The results of the statistical test showed that there was a relationship between education and anxiety in pregnant women in the third trimester with a p-value of 0.002. 5 Nurbaya, A. P., and Munawaroh, M. (2023) The effect of hypnobirthing relaxation on the level of anxiety of primigravida mothers in the third trimester in facing childbirth preparation at the Pandeglang Bougenville clinic The research was conducted at the Clinic Bougenville Pandeglang Banten in the year 2022 The research employed a quasiexperimental design to assess the impact of hypnobirthing relaxation on anxiety levels among primigravida mothers in their third trimester A total of 30 participants were involved, divided into two groups: hypnobirthing and control The study found a significant decrease in anxiety levels among primigravida mothers in their third trimester after undergoing hypnobirthing treatment. The mean pretest anxiety level was 26.5333 with a standard deviation of 10.34316, while the mean posttest anxiety level dropped to 18.8667 with a standard deviation of 8.74125. The statistical analysis revealed a p-value of 0.000, indicating that the hypnobirthing intervention had a significant effect on reducing anxiety levels. The results suggest that hypnobirthing can effectively prepare mothers mentally for childbirth, leading to lower anxiety during the delivery process World Journal of Advanced Research and Reviews, 2025, 26(03), 2449-2456 2453 6 Kartika, I., and Claudya, T. P. (2021) The relationship between family support and the level of anxiety of pregnant women facing the childbirth process at PMB Midwife C Bandung City This study uses a cross-sectional approach. The sample was taken using the accidental sampling technique, resulting in a sample size of 35 people. The results showed that most families did not support pregnant women in facing childbirth, namely 54.3% and almost half of the mothers experienced mild anxiety symptoms in facing childbirth, namely 37.1%. The results of the study showed that there was no relationship between family support and the level of anxiety of pregnant women facing childbirth in PMB Bd. C, Bandung City. 7 Sulistiyaningsi h, S. H., and Rofika, A. (2020). The effect of prenatal gentle yoga on anxiety levels of primigravida pregnant women in the third trimester primigravida pregnant women TM III at Miriam Hospital Kudus The research used is Pre-experimental design with one group pretest posttest design using one group of subjects and measurements were carried out before and after treatment. as many as 30 pregnant women were taken using the total sampling technique. Based on the research results, it can be concluded that there is a significant influence before and after prenatal gentle yoga is carried out with a sig value (-2 tailed) = 0.000 so that 0.000 <0.05 which indicates that there is an influence of prenatal gentle yoga on the level of anxiety of pregnant women in the third trimester of primigravida in facing childbirth. 8 Hafsa, A., Suroso, S., and Pratitis, N. T. (2024)) Husband's Support and Knowledge about Birth with Anxiety Facing Primigravida Birth The research was conducted at the Bakunase Health Center, Kupang City, Indonesia The research employs quantitative methods to analyze the data collected from participants. It focuses on two independent variables: husband's support and knowledge about childbirth targeting 102 primigravida participants The research findings indicate that the majority of participants experience high levels of anxiety regarding childbirth, with 43.1% categorized as high anxiety, 41.2% as medium, and 15.7% as low anxiety. Knowledge about childbirth was also assessed, revealing that 62.7% of participants fell into the high knowledge category, while 29.4% were medium and 7.8% were low. The study found a negative relationship between both husband's support and knowledge about childbirth with anxiety levels, with effective contributions of 8.33% and 30.97% respectively. The practical implications suggest the need for focused reproductive health education programs to enhance husband involvement and improve knowledge about childbirth. 9 Subratha, H. F. A., Giri, K. E., Sulyastini, N. K., and Widiarta, M. B. O. (2023). Anxiety of Pregnant Women Facing Childbirth In Busungbiu District, Buleleng The study was conducted at the Busungbiu I Health Center in Buleleng, Indonesia The study employs a quantitative and descriptive research design a sample of 80 pregnant women selected through random he study found that among third-trimester pregnant women at the Busungbiu I Health Center, the majority experienced moderate anxiety, with 35% reporting this level of anxiety. Younger pregnant women, particularly those under 20 years old, exhibited higher anxiety levels compared to older women. World Journal of Advanced Research and Reviews, 2025, 26(03), 2449-2456 2454 probability sampling Additionally, women with lower educational attainment, such as those who completed only primary or secondary education, had a higher incidence of moderate anxiety. The findings underscore the need for targeted interventions to support pregnant women in managing anxiety, especially during the challenges posed by the Covid-19 pandemic 10 Sofiati, F., Widayati, E., Lestari, R., and Abdillah, S. (2022) Characteristics Associated With Anxiety in Primigravida Mothers Facing Labor in Cianjur District in the Practice of Independent Midwives NY U in Cianjur district The study utilized a questionnaire divided into two parts: respondent characteristics and anxiety symptoms assessment using the HRS-A scale The subjects of the study included 35 primigravida pregnant women in their third trimester19 The study found a significant relationship between age and anxiety levels in primigravida pregnant women, with chi-square test results of 0.001 and an odds ratio (OR) of 3.672 at a 95% confidence level, indicating that older age correlates with higher emotional maturity and better coping abilities during pregnancy. Additionally, there was a significant relationship between economic status and anxiety levels, with chi-square results of 0.003 and an OR of 1.552, suggesting that better economic conditions can alleviate anxiety in pregnant women. The research highlights the importance of socio-economic factors in managing anxiety during pregnancy World Journal of Advanced Research and Reviews, 2025, 26(03), 2449-2456 2455 4. Discussion Findings from 10 articles show that COVID-19 has varying impacts on pregnant women who give birth in health facilities, with mothers worried about contracting the virus and endangering their unborn child. There are differences in anxiety levels in primigravida and multigravida pregnant women. The causes of anxiety are caused by several factors included in this study, including: maternal age, education level, occupation and first birth experience (Wanda, et.al. in, Alza and Ismarwati., 2017). One of the causes of pregnant women experiencing excessive anxiety is due to the level of education which shows that the lower the level of education of a person, the greater the level of anxiety felt by a person. This is supported by the theory that the higher a person's level of education, the better their level of knowledge (Notoadmojo, 2016). The results of the study shared that social support has a negative correlation with the level of anxiety in high-risk pregnant women. Social support from the husband is one of the factors that influences the level of anxiety of mothers during pregnancy towards the labor process. Some forms of support that can be given include care, assistance during pregnancy check-ups or during labor, provision of transportation and provision of pregnancy and labor costs. labor costs. Social support from the husband in the run-up to labor is very much expected by mothers because the presence of the husband will minimize the anxiety experienced by mothers during the labor process. Support that can be given through prayer, touch, motivation, and assistance will reduce anxiety, worry, fear of mothers and make them able to struggle in giving birth to their children. 5. Conclusion From the results of the study it can be concluded that: anxiety in facing childbirth can be experienced by pregnant women, both primigravida and multigravida. The factors that cause anxiety are age, education, giving aromatherapy, hypnobirthing relaxation and yoga exercises. Compliance with ethical standards Acknowledgments The authors acknowledge the reviewer’s positive insights and suggestions in this paper. Disclosure of conflict of interest There is one finding that contradict the theory. References [1] Batubara, Novita Sari, Daulay, Nanda Masraini, and Rangkuti, Nur Aliyah. (2020). The Effect of Belly Dance on Anxiety Levels in Primigravida Pregnant Women in the Third Trimester. Journal of Education and Development, 8(4), 536. [2] Hafsa, A., Suroso, S., and Pratitis, NT (2024). Husband's Support and Knowledge about Childbirth with Anxiety Facing Primigravida Childbirth. World Science Journal, 3(1), 48-57. [3] Halil, A., and Puspitasari, E. (2023). Factors that cause anxiety in third trimester pregnant women in facing childbirth at the Depok 2 Health Center. Journal of Health, 12(1), 78-83. [4] Kartika, I., and Claudya, T. P. (2021). Relationship between family support and anxiety levels of pregnant women facing the labor process. Journal of Midwifery and Public Health, 3(2), 47-52. [5] Muzayyana, M., and Saleh, S. N. H. (2021). Analysis of Anxiety Level Factors of Pregnant Women in the Third Trimester in Facing the Labor Process During the Covid-19 Pandemic in Kotamobagu City. Muhammadiyah Nursing Journal, 6(3). [6] Nurbaya, A. P., and Munawaroh, M. (2023). 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